Puffy, droopy eyes and always looking tired. Do I need a brow lift or blepharoplasty? (Photo)

Question

I'm 23 and my eyes are always puffy, droopy and I struggle to see properly without raising my eyebrows up. I always look tired and grumpy and my eyebrows have become very uneven over the years. They're the worst in the morning, sometimes so puffy with so much excess skin that I can barely open them. What procedure will be best? Blepharoplasty? Or is there something else like a brow lift that I would benefit from?

Benjamin Caughlin, MD, FACS · Answer

You are young for a surgical procedure to correct this. I say that because surgery has a permanent quality and the last thing you want to do is change the way you look now and be unhappy. Have you tried anything? Brow asymmetry is the most common asymmetry and a good number of people have this. Botox can help and even fix this if it brothers you. 
As far as the lids and skin issues go, I would make sure to see someone well versed in medical conditions that lead to these issues. Sometime there are inflammatory conditions that can cause this sensation and problem, especially if you feel it fluctuates with time. If all of these conditions are ruled out then and upper lid blepharoplasty would be your best, simple, and most conservative approach to help you obtain a lighter and softer appearance to your upper lid. Be patient and approach this carefully, as you are young and good looking. You only need a small adjustment.
  
Hope this helps.
  
Best of luck,
DrC

Jason Emer, MD · Answer

As we age, our eyelids naturally sag and droop. A combination approach would be best to see visible improvement. In terms of non-surgical treatment options, I would recommend a Chemical Brow Lift (using Botox, Dysport, Xeomin, or Jeuveau) and filler injections to rejuvenate the temples, eyebrow, eyelid, eye troughs, upper eye hollows, and forehead. I typically combine this with Ultherapy and thread lifting to lift the brow; RF and skin tightening laser treatments to stimulate collagen production and rejuvenate the skin; and laser or superficial RF devices for improvements in texture, color, and any crepey skin around the eyes as needed. In some cases, surgery is the best solution to achieve the desired results. See an expert for a formal consultation. Best, Dr. Emer.​

Jed H. Horowitz, MD, FACS · Answer

Hello rhirhikA Brow Lift (also known as a Forehead Lift or an Upper Face Lift) is a surgical procedure designed to lift the brow and eliminate wrinkles on the forehead. People with droopy or sagging brows can have a sad, angry, or tired appearance; a brow lift can make that person look more happy and energetic. I would advice you schedule a consultation with a board certified plastic surgeon

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. I suggest that you move forward and consult with a board certified facial plastic surgeon because at your age you may be a candidate for non-surgical procedures, such as fillers, lasers or peels.
Best wishes,

Mehryar (Ray) Taban, MD, FACS · Answer

You have asymmetric upper eyelid ptosis, worse in the left eye. That requires ptosis surgery which is different than blepharoplasty or brow surgery. See an oculoplastic surgeon for evaluation.

Pedram Imani, FRACS, MS, MBBS (Hons) · Answer

Based on the photos and the description that you have provided there are a number of reasons why you may have puffy tired eyes:1. Genetics - do your parents have similar eye lid problems2. Allergies - a very common cause for puffy eyes3. Excess upper eyelid skin 4. Excess periocular muscle activity or muscle inactivity 5. Systemic illness - autoimmune disease, or other metabolic disordersAll these need through in person assessment by a specialist prior to deciding on the best course of treatment.  There are a myriad of things that can be done both surgical and non surgical.  Botox/Xeomin injections, blepharoplasty, and treatment of allergies to name a few.  Browlift is however not required in your case.  Please see a qualified facial plastic or oculoplastic surgeon for best results.  Hope this is helpful.

Wenjing Liu, MD · Answer

Dear rhirhik,
It does not look like your brows are low or that you have a lot of excess skin on your upper eyelids. You do have some mild ptosis of both upper eyelids with the left upper eyelid a little lower than the right. I recommend that you see an Oculoplastic surgeon for evaluation to consider ptosis surgery or you can try some Botox to the eyelid orbicularis muscle to see if it opens the eyes up a little more. 
Best,
Dr. Liu

Kristin J. Tarbet, MD, FACS · Answer

Hello and thank you for your question. I think you would benefit from neurotoxins, either Xeomin or Botox to refresh your look. I certainly do not see the need for surgical intervention at your young age. Botox injections with a skilled injector can refresh and maintain that freshness with continued treatments 3.5 to 4 months apart. Give it a try. Good luck to you .

Patrick Flaharty, MD FAACS · Answer

Your eyebrow height, shape and contour appear normal. Many people have some slight brow asymmetry and if this is of concern it can be corrected with Botox.  There is some redundancy of skin on the upper eyelids. Of course we all need some redundancy in our eyelids for proper function (open, close, look up, look down).  If you feel the skin is excessive causing hooding or too much fullness then a conservative blepharoplasty could be helpful.

Ivan Vrcek, MD, FACS · Answer

Thank you for your photo and question.
In my opinion, your brows are in a very nice position. I do see the fullness in your upper eyelids that you are noticing. This could be improved with a thoughtfully performed upper blepharoplasty. Sometimes a "tired" look can come from upper eyelid ptosis or lower eyelid retraction. I do not see much of either of these in your photos; however, an in-person evaluation would be best to check for these. Consider finding an oculoplastic surgeon in your area for a consultation.
Best of luck!

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